neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2021-23-4-18-32neurosurgery-1116Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTОсложнения стереотаксического радиохирургического лечения заболеваний головного мозгаComplications after stereotactic radiosurgery in patients with brain disordershttps://orcid.org/0000-0002-8415-5602ТокаревА. С.TokarevA. S.

127006 Москва, Оружейный пер., 43

129010 Москва, Б. Сухаревская пл., 3

43 Oruzheyniy Per., Moscow 127006

3 Bolshaya Sukharevskaya Ploshchad, Moscow 129010

https://orcid.org/0000-0002-4534-8719РакВ. А.RakV. A.

129010 Москва, Б. Сухаревская пл., 3

3 Bolshaya Sukharevskaya Ploshchad, Moscow 129010

https://orcid.org/0000-0002-8502-7792ТерехинИ. А.TerekhinI. A.

129010 Москва, Б. Сухаревская пл., 3

3 Bolshaya Sukharevskaya Ploshchad, Moscow 129010

https://orcid.org/0000-0002-0635-6783НезнановаМ. В.NeznanovaM. V.

Мария Викторовна Незнанова  

129010 Москва, Б. Сухаревская пл., 3

Mariya Viktorovna Neznanova 

3 Bolshaya Sukharevskaya Ploshchad, Moscow 129010

mashaneznanova@inbox.ruhttps://orcid.org/0000-0001-8099-9544ЕвдокимоваО. Л.EvdokimovaO. L.

129010 Москва, Б. Сухаревская пл., 3

3 Bolshaya Sukharevskaya Ploshchad, Moscow 129010

https://orcid.org/0000-0003-0007-8054СтепановВ. Н.StepanovV. N.

129010 Москва, Б. Сухаревская пл., 3

3 Bolshaya Sukharevskaya Ploshchad, Moscow 129010

МакеевП. А.MakeevP. A.

115184 Москва, Большая Татарская ул., 30

30 Bolshaya Tatarskaya St., Moscow 115184

https://orcid.org/0000-0002-2221-6641ВиктороваО. А.ViktorovaO. A.

129010 Москва, Б. Сухаревская пл., 3

3 Bolshaya Sukharevskaya Ploshchad, Moscow 129010

Департамент здравоохранения города Москвы; ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского Департамента здравоохранения г. Москвы»РоссияMoscow Healthcare Department; N.V. Sklifosovskiy Research Institute of Emergency Medicine, Moscow Healthcare DepartmentRussian FederationГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского Департамента здравоохранения г. Москвы»РоссияN.V. Sklifosovskiy Research Institute of Emergency Medicine, Moscow Healthcare DepartmentRussian FederationГБУ «Научно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения г. Москвы»РоссияResearch Institute of Health Care Organization and Medical Management, Moscow Healthcare DepartmentRussian Federation2021180120222341832Copyright © Токарев А.С., Рак В.А., Терехин И.А., Незнанова М.В., Евдокимова О.Л., Степанов В.Н., Макеев П.А., Викторова О.А., 20222022Токарев А.С., Рак В.А., Терехин И.А., Незнанова М.В., Евдокимова О.Л., Степанов В.Н., Макеев П.А., Викторова О.А.Tokarev A.S., Rak V.A., Terekhin I.A., Neznanova M.V., Evdokimova O.L., Stepanov V.N., Makeev P.A., Viktorova O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1116

Цель исследования – анализ осложнений стереотаксического радиохирургического лечения различных заболеваний головного мозга на аппарате Elekta Leksell Gamma Knife Perfexion.Материалы и методы. Проведен ретроспективный анализ результатов радиохирургического лечения 3148 пациентов, из них пациенты с метастазами – 1621 (51,5 %), менингиомами – 732 (23,3 %), невриномами – 359 (11,4 %), артериовенозными мальформациями – 71 (2,3 %), каверномами – 118 (3,7 %), нейроэпителиальными опухолями – 114 (3,6 %), аденомами гипофиза – 46 (1,5 %), функциональными заболеваниями – 54 (1,7 %), с другими заболеваниями – 33 (1 %).Для постановки диагнозов проводили неврологический осмотр, использовали данные магнитно-резонансной и компьютерной томографии, а также позитронно-эмиссионной томографии.Тяжесть лучевых осложнений оценена по шкале Eastern Cooperative Oncology Group (ECOG).Результаты. Из всех пациентов, которым было проведено стереотаксическое радиохирургическое лечение, у 96 пациентов было выявлено 97 различных осложнений. Среди неспецифических осложнений превалировали радионекроз (n = 43) и перифокальный отек (n = 38), реже встречались алопеция (n = 3) и учащение эпилептических приступов (n = 3). Специфических осложнений было меньше: неокклюзионная гидроцефалия развилась у 3 пациентов, поражение черепно-мозговых нервов – у 6 пациентов и эндокринные нарушения – у 1 пациента. Общий процент радиационно-индуцированных осложнений составил 3,08 %.Заключение. На основе анализа данных, полученных в нашем центре, мы определили, что стереотаксическая радиохирургия является безопасным методом лечения различных заболеваний головного мозга с низким процентом развития послеоперационных осложнений. Частота развития осложнений не превысила процент осложнений по данным мировой и отечественной литературы.

Objective: to analyze complications after stereotactic radiosurgery for various diseases performed using the Elekta Leksell Gamma Knife Perfexion.Materials and methods. This retrospective study of stereotactic radiosurgery outcomes included 3,148 patients with different brain lesions, including 1,621 individuals with metastases (51.5 %), 732 with meningiomas (23.3 %), 359 with neurinomas (11.4 %), 71 with arteriovenous malformations (2.3 %), 118 with cavernomas (3.7 %), 114 with neuroepithelial tumors (3.6 %), 46 with pituitary adenomas (1.5 %), 54 with functional diseases (1.7 %), and 33 with other diseases (1 %).The diagnosis was based on the results of neurological examination, magnetic resonance imaging, computed tomography, and positron emission tomography.The severity of radiation complications was evaluated using the Eastern Cooperative Oncology Group (ECOG) scale.Results. Among all patients who underwent stereotactic radiosurgery, 96 individuals developed 97 different complications. The most common complications included radionecrosis (n = 43) and perifocal edema (n = 38). Alopecia (n = 3) and increased frequency of epileptic seizures (n = 3) were less common. We observed very few specific complications, such as non-obstructive hydrocephalus (n = 3), cranial nerve lesions (n = 3), and endocrine disorders (n = 1). The total rate of radiation-induced complications was 3.08 %.Conclusion. Our findings suggest that stereotactic radiosurgery is a safe treatment for various brain diseases and is characterized by a low rate of postoperative complications. The incidence of postoperative complications in this study did not exceed that reported in Russian and foreign literature.

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The authors declare that there are no conflicts of interest present.